PANCREAS AND ISLET TRANSPLANTATION

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PANCREAS AND ISLETTRANSPLANTATION

• 2003 Clinical Practice Guidelines
• for the Prevention and Management
• of Diabetes in Canada

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WHOLE PANCREAS TRANSPLANTATION

• Whole pancreas transplantation can occur at the
  same time as a kidney transplant (SPK), after a
  kidney transplantation (PAK) or alone (PTA).
• Using modern immunosuppression, one centre has
  reported the following results
• SPK PAK PTA
• 1-year patient survival 92 98 100
• 1-year graft survival 79 81 88
• Successful pancreas transplant can deliver superb
  glycemic control and can stabilize or improve
  diabetic complications.

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ISLET TRANSPLANTATION

• Islet transplantation is a much simpler procedure
  than whole pancreas transplantation.
• The current indications for islet transplantation
  are extreme lability of glycemic control and/or
  recurrent severe hypoglycemia, especially if
  awareness of hypoglycemia is diminished.
• Normoglycemia can usually be established after
  transplantation.
• It is too early to evaluate the effect on
  long-term complications. Short-term complications
  from the procedure and the immunosuppresive drugs
  have been seen.

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PANCREAS TRANSPLANTION- RECOMMENDATIONS

• In centres with personnel appropriately skilled
  in the technical aspects of the surgery, pancreas
  transplantation is a preferred option for
  patients whose type 1 diabetes has been difficult
  to control and who are undergoing kidney
  transplantation for diabetic nephropathy Grade
  D, Consensus. Whole organ transplant for
  nonuremic patients remains a high-risk procedure,
  and should be considered only for the patient
  with persistent major problems with diabetes
  control resulting in significant lifestyle
  disruption despite efforts at intensive insulin
  therapy Grade D, Consensus.

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ISLET TRANSPLANTION- RECOMMENDATIONS

• In centres with personnel appropriately skilled
  in the technical aspects of islet isolation and
  clinical use of immunosuppression, islet
  transplantation is an option for patients whose
  type 1 diabetes has been particularly difficult
  to control and that is associated with
  significant lifestyle disruption despite optimal
  medical therapy Grade D, Consensus.